暴发性胰腺炎手术指征及手术时机的探讨  

Indications and timing of surgery in fulminant acute pancreatitis

作　　者：余枭[1] 朱红伟[1] 李霞[2] 余灿[1] 杨明施[3] 陈道瑾[1] 李小荣[1] 

机构地区：[1]中南大学湘雅三医院普通外科,湖南长沙410013 [2]中南大学湘雅三医院内分泌科,湖南长沙410013 [3]中南大学湘雅三医院重症监护室,湖南长沙410013

出　　处：《中国普通外科杂志》2014年第3期310-313,共4页China Journal of General Surgery

摘　　要：目的：探讨暴发性胰腺炎（FAP）的手术指征及最佳手术时机。方法：回顾性分析2004年8月-2012年8月收治32例接受手术治疗的FAP患者临床资料。结果：32例FAP患者在不同情况下接受手术治疗，其中13例在最大限度ICU治疗10～14d后，多器官功能障碍持续存在无好转；8例在最大限度ICU治疗3-5d后多器官功能无好转，且迅速恶化；11例腹室高压经过一系列非手术治疗后仍持续维持在30cmH2O（1cm H2O=0．098kPa）以上。全组治愈率为78．1％（25／32），病死率为21．9％（7／32）。19例获随访4-50个月，其中5例患者术后出现胰腺假性囊肿，二次手术治疗治愈。结论：在进行最大限度ICU治疗后多器官功能仍无好转或进一步恶化，或腹室高压经非手术治疗后仍持续不降的FAP患者，应采取积极手术干预。Objective： To investigate the indications and optimal time of surgery in fulminant acute pancreatitis （FAP）. Methods： The clinical data of 32 FAP patients undergoing surgical treatment from August 2004 to August 2012 were retrospectively analyzed. Results： All the 32 FAP patients underwent surgical management for different reasons, which in 13 cases was due to the persistence of multiple organ dysfunction without any evidence of improvement after receiving 10- to 14-d full ICU care, in 8 cases was ascribed to no improvement but even rapid worsening of multiple organ functions after receiving 3- to 5-d full ICU care; and in 11 cases was attributed to sustained intra-abdominal pressure above 30 cmH20 （1 cmH20=0.098 kPa） after a series of non-surgical procedures. The cure rate for the entire group of patients was 78.1% （25/32）, and the mortality was 21.9% （7/32）. Ninety patients were followed-up for 4 to 50 months, and 5 cases developed pancreatic pseudocyst, which were resolved by a second operation. Conclusion： Aggressive surgical intervention is ）ustified in FAP patients with no evidence of improvementor even deterioration of multiple organ functions after full ICU care, or having sustained intra-abdominal hypertension without signs of relief after non-surgical treatment.

关 键 词：胰腺炎 急性坏死性 外科学 手术指征 手术时机 

分 类 号：R657.5[医药卫生—外科学]